@layout("/common/_container.html"){
<style>
    ul {
        margin: 0;
        padding: 0;
    }

    .ulBox {
        display: flex
    }

    .ulBox > li {
        flex: 1;
    }

    .ulBox > li > ul > li {
        margin-top: 10px;
    }

    #surfaceBox {
        /*display: flex;*/
        height: 100%;
        background: white;
    }

    #surface_left {
        flex: 1;
        background: #cccccc;
        height: 100%;
        display: flex;
        text-align: center;
        flex-direction: column;
    }

    #surface_left > div {
        flex: 1;
    }

    #surface_right {
        /*flex: 7;*/
        background: white
    }

    /*#surface_right > div {*/
    /*display: none*/
    /*}*/

    #surface_right h5 {
        margin: 0;
        padding: 30px 0 10px 20px;
        border-bottom: 1px solid #e0e0e0;
        color: #2b8bd5;
        font-size: 1.6em;
    }

    #requiredOne > div, #requiredTwo > div, #requiredThr > div, #selectionOne > div, #selectionTwo > div, #selectionThr > div ,
    #selectionFor > div , #selectionFive > div{
        padding: 0 2.5em;
    }

    #requiredBox {
        padding: 20px 0 20px;
    }

    #requiredBox .ulBox div {
        margin: 10px 0;
    }

    #requiredBox .ulBox div input, #requiredBox .ulBox div select ,#requiredBox .grid >div input ,#requiredBox .grid > div select{
        outline: none;
        border-radius: 5px;
        border: 1px solid #cccccc;
        width: 60%;
        background: none;
        height: 2em;
        padding-left: 10px;
        font-size: 17px;
    }

    #requiredBox .grid  > div{margin-bottom: 10px;}

    #requiredBox .ulBox div span {
        display: inline-block;
        width: 3em;
        font-size: 19px;
        font-weight: 700;
    }

    #selectionBox {
        padding-top: 20px;
    }

    #determineBox {
        /*position: absolute;*/
        /*bottom: 8%;*/
        /*left: 50%;*/
        /*transform: translateX(-50%);*/
        background: url("${ctxPath}/static/img/ipad_login_03.png") no-repeat;
        background-size: cover;
        overflow: hidden;
        outline: none;
        margin: 0 auto;
    }

    #determine {
        color: white;
        padding: 0;
        margin: 0;
        background: none;
        line-height: 50px;
        font-size: 19px;
    }

    .pay_list_c1 {
        display: inline-block;
        width: 25px;
        height: 25px;
        background: #DCDCDC;
        border: 1px solid #535353;
        border-radius: 5px;

    }

    .required{font-size: 19px;margin:0 10px 0;}

    .radioclass {
        opacity: 0;
        cursor: pointer;
        -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=0)";
        filter: alpha(opacity=0);
    }
</style>


<div style="display: none">
    <input type="hidden" id="provinceValue" value="">
    <input type="hidden" id="citiesValue" value="">
    <input type="hidden" id="regionValue" value="">
    <input type="hidden" id="customerSexValue" value="${customerInfo.sex}">
    <input type="hidden" id="phoneSharShipValue" value="${customerInfo.phoneSharShip}">
</div>
<div id="surfaceBox">
    <!--<div id="surface_left">-->
    <!--<div id="required" style="position: relative">-->
    <!--<div style="position: absolute;top:50%;left: 0;right: 0;transform: translateY(-50%);">-->
    <!--<h2>基础信息</h2>-->
    <!--<h2>(必填)</h2>-->
    <!--</div>-->
    <!--</div>-->
    <!--<div id="selection" style="position: relative">-->
    <!--<div style="position: absolute;top:50%;left: 0;right: 0;transform: translateY(-50%);">-->
    <!--<h2>过往史</h2>-->
    <!--<h2>(选填)</h2>-->
    <!--</div>-->
    <!--</div>-->
    <!--</div>-->
    <div id="surface_right">
        <div id="requiredBox">
            <div id="requiredOne">
                <!--<div class="row">-->
                <!--<div class="grid clearfix">-->
                <!--<div class="col-sm-4 col-xs-6">-->
                <!--<span>姓名</span>-->
                <!--<input type="text" id="customerName" name="customerName">-->
                <!--</div>-->
                <!--<div class="col-sm-4 col-xs-6">-->
                <!--<span>手机</span>-->
                <!--<input type="text" id="customerPhone" name="customerPhone" value="${customerPhone}">-->
                <!--</div>-->
                <!--<div class="col-sm-4 col-xs-6">-->
                <!--<span>性别</span>-->
                <!--<select id="customerSex" name="customerSex">-->
                <!--<option value="1">男</option>-->
                <!--<option value="2">女</option>-->
                <!--</select>-->
                <!--</div>-->
                <!--<div class="col-sm-4 col-xs-6">-->
                <!--<span>年龄</span>-->
                <!--<input type="text" id="customerAge" name="customerAge" maxlength="3" onkeyup="value=value.replace( /[^\d]/g,'')">-->
                <!--</div>-->
                <!--<div class="col-sm-4 col-xs-6">-->
                <!--<span>职业</span>-->
                <!--<input type="text" id="occupation" name="occupation">-->
                <!--</div>-->
                <!--<div class="col-sm-4 col-xs-6">-->
                <!--<span>省份</span>-->
                <!--<select id="province" name="province"></select>-->
                <!--</div>-->
                <!--<div class="col-sm-4 col-xs-6">-->
                <!--<span>城市</span>-->
                <!--<select id="cities" name="cities"></select>-->
                <!--</div>-->
                <!--<div class="col-sm-4 col-xs-6">-->
                <!--<span>区域</span>-->
                <!--<select id="region" name="region"></select>-->
                <!--</div>-->
                <!--<div class="col-sm-4 col-xs-6">-->
                <!--<span>地址</span>-->
                <!--<input id="address" name="address"/>-->
                <!--</div>-->
                <!--</div>-->
                <!--</div>-->

                <div>
                    <ul class="ulBox">
                        <li>
                            <div>
                                <span>姓名</span>
                                <input type="text" id="customerName" name="customerName"
                                       value="${customerInfo.customerName}">
                            </div>
                            <div>
                                <span>性别</span>
                                <select id="customerSex" name="customerSex" >
                                    <option value="1">男</option>
                                    <option value="2">女</option>
                                </select>
                            </div>
                            <div>
                                <span>年龄</span>
                                <input type="text" id="customerAge" name="customerAge"  maxlength="3"
                                       value="${customerInfo.customerAge}"
                                       maxlength="3" onkeyup="value=value.replace( /[^\d]/g,'')">
                            </div>
                            <div>
                                <span>手机</span>
                                <input type="text" id="customerPhone" name="customerPhone" style="width: 37%;vertical-align: middle"
                                       value="${customerInfo.customerPhone}"   >
                                <select class="form-control" id="phoneSharShip" name="phoneSharShip" style="width: 22.5%;vertical-align: middle;display: inline-block">
                                    <option value="本人">本人</option>
                                    <option value="爸爸">爸爸</option>
                                    <option value="妈妈">妈妈</option>
                                    <option value="儿子">儿子</option>
                                    <option value="女儿">女儿</option>
                                    <option value="朋友">朋友</option>
                                    <option value="其他">其他</option>
                                </select>
                            </div>
                            <div style="margin: 0;">
                                <span>职业</span>
                                <input type="text" id="occupation" name="occupation"
                                       value="${customerInfo.occupation}" >
                            </div>
                        </li>
                        <li>
                            <div>
                                <span>国家</span>
                                <select id="country" name="country"
                                        value="${customerInfo.country}">
                                    <option value="中国">中国</option>
                                </select>
                            </div>
                            <div>
                                <span>省份</span>
                                <select id="province" name="province"
                                        value="${customerInfo.province}"></select>
                            </div>
                            <div>
                                <span>城市</span>
                                <select id="cities" name="cities"
                                        value="${customerInfo.cities}"></select>
                            </div>
                            <div>
                                <span>区域</span>
                                <select id="region" name="region"
                                        value="${customerInfo.region}"></select>
                            </div>
                            <div>
                                <span>地址</span>
                                <input id="address" name="address"
                                       value="${customerInfo.address}"/>
                            </div>
                        </li>
                    </ul>
                </div>
            </div>
            <div id="requiredTwo">
                <h5>就诊原因（点击勾选）</h5>
                <div style="padding-top: 15px;">
                    <ul class="ulBox">
                        <li>
                            <ul>
                                <li>
                                    <label for="inspect" class="pay_list_c1 requireds" style="background: #289bd6"><input
                                            class="radioclass" type="radio" id="inspect" name="reason" value="检查"
                                            checked="checked"/></label>
                                    <label class="required" for="inspect">检查</label>
                                </li>
                                <li>
                                    <label for="scars" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="scars" name="reason"
                                                                               value="祛疤色素"/></label>
                                    <label class="required" for="scars">祛疤色素</label>
                                </li>
                                <li>
                                    <label for="toothache" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="toothache" name="reason" value="牙疼"/></label>
                                    <label class="required" for="toothache">牙疼</label>
                                </li>
                                <li>
                                    <label for="toothLoosening" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="toothLoosening" name="reason"
                                                                               value="牙齿松动"/></label>
                                    <label class="required" for="toothLoosening">牙齿松动</label>
                                </li>
                                <li>
                                    <label for="toothLoss" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="toothLoss" name="reason"
                                                                               value="牙齿缺失"/></label>
                                    <label class="required" for="toothLoss">牙齿缺失</label>
                                </li>
                                <li>
                                    <label for="periodontitis" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="periodontitis" name="reason"
                                                                               value="牙周病"/></label>
                                    <label class="required" for="periodontitis">牙周病</label>
                                </li>

                            </ul>
                        </li>
                        <li>
                            <ul>
                                <li>
                                    <label for="filming" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="filming" name="reason"
                                                                               value="拍片"/></label>
                                    <label class="required" for="filming">拍片</label>
                                </li>
                                <li>
                                    <label for="whitening" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="whitening" name="reason" value="美白"/></label>
                                    <label class="required" for="whitening">美白</label>
                                </li>
                                <li>
                                    <label for="toothExtraction" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="toothExtraction" name="reason"
                                                                               value="拔牙"/></label>
                                    <label class="required" for="toothExtraction">拔牙</label>
                                </li>
                                <li>
                                    <label for="swelling" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="swelling" name="reason" value="肿胀"/></label>
                                    <label class="required" for="swelling">肿胀</label>
                                </li>
                                <li>
                                    <label for="plant" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="plant" name="reason"
                                                                               value="想做种植"/></label>
                                    <label class="required" for="plant">想做种植</label>
                                </li>
                                <li>
                                    <label for="arrangement" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="arrangement" name="reason"
                                                                               value="牙齿排列不齐"/></label>
                                    <label class="required" for="arrangement">牙齿排列不齐</label>
                                </li>

                            </ul>
                        </li>
                        <li>
                            <ul>
                                <li>
                                    <label for="scaling" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="scaling" name="reason"
                                                                               value="洁牙/牙龈出血"/></label>
                                    <label class="required" for="scaling">洁牙/牙龈出血</label>
                                </li>
                                <li>
                                    <label for="toothFilling" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="toothFilling" name="reason"
                                                                               value="补牙"/></label>
                                    <label class="required" for="toothFilling">补牙</label>
                                </li>
                                <li>
                                    <label for="trauma" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="trauma" name="reason"
                                                                               value="折断/折裂/外伤"/></label>
                                    <label class="required" for="trauma">折断/折裂/外伤</label>
                                </li>
                                <li>
                                    <label for="wisdomTooth" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="wisdomTooth" name="reason"
                                                                               value="智齿发炎"/></label>
                                    <label class="required" for="wisdomTooth">智齿发炎</label>
                                </li>
                                <li>
                                    <label for="cosmeticRepair" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="cosmeticRepair" name="reason"
                                                                               value="美容修复"/></label>
                                    <label class="required" for="cosmeticRepair">美容修复</label>
                                </li>
                                <li>
                                    <label for="correct" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="correct" name="reason" value="矫正调整"/></label>
                                    <label class="required" for="correct">矫正调整</label>
                                </li>
                            </ul>
                        </li>
                    </ul>
                </div>
            </div>
            <div id="requiredThr">
                <h5>来院途径（点击勾选）</h5>
                <div style="padding:15px 2.5em 20px;" id="projectData" class="clearfix">
                    <ul class="ulBox">
                        <li>
                            <ul>
                                <li>
                                    <label for="treatment" class="pay_list_c1 requireds" style="background: #289bd6"><input
                                            class="radioclass" type="radio" id="treatment" name="selectReasons" value="社区义诊"
                                            checked="checked"/></label>
                                    <label class="required" for="treatment">社区义诊</label>
                                </li>
                                <li>
                                    <label for="newspaper" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="newspaper" name="selectReasons"
                                                                               value="报纸"/></label>
                                    <label class="required" for="newspaper">报纸</label>
                                </li>
                                <li>
                                    <label for="outdoor" class="pay_list_c1 requireds"><input
                                            class="radioclass" type="radio" id="outdoor" name="selectReasons" value="户外棚子"/></label>
                                    <label class="required" for="outdoor">户外棚子</label>
                                </li>
                                <li>
                                    <label for="cashCoupon" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="cashCoupon" name="selectReasons"
                                                                               value="代金券"/></label>
                                    <label class="required" for="cashCoupon">代金券</label>
                                </li>
                                <li>
                                    <label for="nearby" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="nearby" name="selectReasons"
                                                                               value="附近的人"/></label>
                                    <label class="required" for="nearby">附近的人</label>
                                </li>
                                <li>
                                    <label for="callBack" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="callBack" name="selectReasons"
                                                                               value="电话回访"/></label>
                                    <label class="required" for="callBack">电话回访</label>
                                </li>
                            </ul>
                        </li>
                        <li>
                            <ul>
                                <li>
                                    <label for="network" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="network" name="selectReasons"
                                                                               value="网络"/></label>
                                    <label class="required" for="network">网络</label>
                                </li>
                                <li>
                                    <label for="elevator" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="elevator" name="selectReasons"
                                                                               value="电梯广告"/></label>
                                    <label class="required" for="elevator">电梯广告</label>
                                </li>
                                <li>
                                    <label for="cooperative" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="cooperative" name="selectReasons"
                                                                               value="合作商家"/></label>
                                    <label class="required" for="cooperative">合作商家</label>
                                </li>
                                <li>
                                    <label for="dentist" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="dentist" name="selectReasons"
                                                                               value="小牙医"/></label>
                                    <label class="required" for="dentist">小牙医</label>
                                </li>
                                <li>
                                    <label for="introduction" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="introduction" name="selectReasons"
                                                                               value="朋友介绍"/></label>
                                    <label class="required" for="introduction">朋友介绍</label>
                                </li>
                                <li>
                                    <label for="beenHere" class="pay_list_c1 requireds"><input
                                            class="radioclass" type="radio" id="beenHere" name="selectReasons" value="以前来过"
                                    /></label>
                                    <label class="required" for="beenHere">以前来过</label>
                                </li>
                            </ul>
                        </li>
                        <li>
                            <ul>
                                <li>
                                    <label for="weChat" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="weChat" name="selectReasons"
                                                                               value="微信"/></label>
                                    <label class="required" for="weChat">微信</label>
                                </li>
                                <li>
                                    <label for="leaflets" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="leaflets" name="selectReasons"
                                                                               value="宣传单"/></label>
                                    <label class="required" for="leaflets">宣传单</label>
                                </li>
                                <li>
                                    <label for="expert" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="expert" name="selectReasons"
                                                                               value="专家讲座"/></label>
                                    <label class="required" for="expert">专家讲座</label>
                                </li>
                                <li>
                                    <label for="american" class="pay_list_c1 requireds"><input
                                            class="radioclass" type="radio" id="american" name="selectReasons" value="美团"
                                    /></label>
                                    <label class="required" for="american">美团</label>
                                </li>
                                <li>
                                    <label for="passBy" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="passBy" name="selectReasons"
                                                                               value="路过"/></label>
                                    <label class="required" for="passBy">路过</label>
                                </li>
                                <li>
                                    <label for="cooperation" class="pay_list_c1 requireds"><input class="radioclass" type="radio"
                                                                               id="cooperation" name="selectReasons"
                                                                               value="瑞尔合作"/></label>
                                    <label class="required" for="cooperation">瑞尔合作</label>
                                </li>
                            </ul>
                        </li>
                    </ul>
                </div>
            </div>
            <div id="determineBox" style="outline:none;text-align: center;width: 112px;height: 53px;margin-top: 25px;">
                <button class="btn" style="outline:none;" type="button" id="determine" onclick="determine()">确定</button>
            </div>
        </div>

        <!--<div id="selectionBox">-->
        <!--<div id="selectionOne">-->
        <!--<h5 style="padding: 10px 0 10px 20px;">现在身体状况</h5>-->
        <!--<div style="padding-top: 15px;" class="clearfix">-->
        <!--<div class="col-sm-2">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio"-->
        <!--name="physicalCondition" id="good"-->
        <!--value="良好"></span>-->
        <!--<label for="good" class="selection" style="font-weight: 500;margin-left: 10px;">良好</label>-->
        <!--</div>-->
        <!--<div class="col-sm-2">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio"-->
        <!--name="physicalCondition" id="poor"-->
        <!--value="不佳"></span>-->
        <!--<label for="poor" class="selection" style="font-weight: 500;margin-left: 10px;">不佳</label>-->
        <!--</div>-->
        <!--<div class="col-sm-2">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio"-->
        <!--name="physicalCondition" id="pregnant"-->
        <!--value="怀孕"></span>-->
        <!--<label for="pregnant" class="selection" style="font-weight: 500;margin-left: 10px;">怀孕</label>-->
        <!--</div>-->
        <!--<div class="col-sm-2">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio"-->
        <!--name="physicalCondition" id="andPregnant"-->
        <!--value="怀孕有孕"></span>-->
        <!--<label for="andPregnant" class="selection"-->
        <!--style="font-weight: 500;margin-left: 10px;">怀孕有孕</label>-->
        <!--</div>-->
        <!--<div class="col-sm-2">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio"-->
        <!--name="physicalCondition" id="lactation" value="哺乳期"></span>-->
        <!--<label for="lactation" class="selection" style="font-weight: 500;margin-left: 10px;">哺乳期</label>-->
        <!--</div>-->
        <!--</div>-->
        <!--</div>-->
        <!--<div id="selectionTwo">-->
        <!--<h5 style="padding: 20px 0 10px 20px;">既往史</h5>-->
        <!--<div style="padding-top: 15px;" class="clearfix">-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="pastHistory"-->
        <!--id="hematopathy" value="血液病"></span>-->
        <!--<label for="hematopathy" class="selection"-->
        <!--style="font-weight: 500;margin-left: 10px;">血液病</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="pastHistory"-->
        <!--id="pacemaker" value="安装心脏起搏器"></span>-->
        <!--<label for="pacemaker" class="selection"-->
        <!--style="font-weight: 500;margin-left: 10px;">安装心脏起搏器</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="pastHistory"-->
        <!--id="hyperthyroidism" value="甲亢"></span>-->
        <!--<label for="hyperthyroidism" class="selection"-->
        <!--style="font-weight: 500;margin-left: 10px;">甲亢</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"> <input class="radioclass" type="radio" name="pastHistory"-->
        <!--id="aids" value="艾滋病"></span>-->
        <!--<label for="aids" class="selection" style="font-weight: 500;margin-left: 10px;">艾滋病</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="pastHistory"-->
        <!--id="nephropathy" value="出血性疾病/肾病"></span>-->
        <!--<label for="nephropathy" class="selection"-->
        <!--style="font-weight: 500;margin-left: 10px;">出血性疾病/肾病</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"> <input class="radioclass" type="radio" name="pastHistory"-->
        <!--id="orthodontics" value="正畸矫正史"></span>-->
        <!--<label for="orthodontics" class="selection"-->
        <!--style="font-weight: 500;margin-left: 10px;">正畸矫正史</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="pastHistory"-->
        <!--id="smoke" value="吸烟"></span>-->
        <!--<label for="smoke" class="selection" style="font-weight: 500;margin-left: 10px;">吸烟</label>-->
        <!--</div>-->
        <!--</div>-->
        <!--</div>-->
        <!--<div id="selectionThr">-->
        <!--<h5 style="padding: 20px 0 10px 20px;">过敏史</h5>-->
        <!--<div style="padding-top: 15px;" class="clearfix">-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="theHistory"-->
        <!--id="penicillin" value="青霉素"></span>-->
        <!--<label for="penicillin" class="selection" style="font-weight: 500;margin-left: 10px;">青霉素</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="theHistory"-->
        <!--id="sulfonamides" value="磺胺类"></span>-->
        <!--<label for="sulfonamides" class="selection"-->
        <!--style="font-weight: 500;margin-left: 10px;">磺胺类</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="theHistory"-->
        <!--id="seafood" value="海鲜"></span>-->
        <!--<label for="seafood" class="selection" style="font-weight: 500;margin-left: 10px;">海鲜</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="theHistory"-->
        <!--id="egg" value="鸡蛋"></span>-->
        <!--<label for="egg" class="selection" style="font-weight: 500;margin-left: 10px;">鸡蛋</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="theHistory"-->
        <!--id="mango" value="芒果"></span>-->
        <!--<label for="mango" class="selection" style="font-weight: 500;margin-left: 10px;">芒果</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="theHistory"-->
        <!--id="other" value="其他"></span>-->
        <!--<label for="other" class="selection"-->
        <!--style="font-weight: 500;margin-left: 10px;">其他</label>-->
        <!--</div>-->
        <!--</div>-->
        <!--</div>-->
        <!--<div id="selectionFor">-->
        <!--<h5 style="padding: 20px 0 10px 20px;">是否注册过局部麻醉</h5>-->
        <!--<div style="padding-top: 15px;" class="clearfix">-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="anaesthesia"-->
        <!--id="selectionYes" value="是"></span>-->
        <!--<label for="selectionYes" class="selection" style="font-weight: 500;margin-left: 10px;">是</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="anaesthesia"-->
        <!--id="selectionNo" value="否"></span>-->
        <!--<label for="selectionNo" class="selection" style="font-weight: 500;margin-left: 10px;">否</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="anaesthesia"-->
        <!--id="discomfort" value="没有不适"></span>-->
        <!--<label for="discomfort" class="selection" style="font-weight: 500;margin-left: 10px;">没有不适</label>-->
        <!--</div>-->
        <!--</div>-->
        <!--</div>-->
        <!--<div id="selectionFive">-->
        <!--<h5 style="padding: 20px 0 10px 20px;">治疗要求</h5>-->
        <!--<div style="padding-top: 15px;" class="clearfix">-->
        <!--<div class="clearfix">-->
        <!--<div class="col-sm-12">-->
        <!--<h6 style="margin-left: -20px;font-weight: bold">时间次数</h6>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="frequency"-->
        <!--id="anytime" value="任何时候"></span>-->
        <!--<label for="anytime" class="selection" style="font-weight: 500;margin-left: 10px;">任何时候</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="frequency"-->
        <!--id="longTime" value="次数少时间长"></span>-->
        <!--<label for="longTime" class="selection" style="font-weight: 500;margin-left: 10px;">次数少时间长</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="frequency"-->
        <!--id="shortTime" value="次数多时间短"></span>-->
        <!--<label for="shortTime" class="selection" style="font-weight: 500;margin-left: 10px;">次数少时间长</label>-->
        <!--</div>-->
        <!--</div>-->
        <!--<div class="clearfix">-->
        <!--<div class="col-sm-12">-->
        <!--<h6 style="margin-left: -20px;font-weight: bold">费用</h6>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="cost"-->
        <!--id="economics" value="经济型"></span>-->
        <!--<label for="economics" class="selection" style="font-weight: 500;margin-left: 10px;">经济型</label>-->
        <!--</div>-->
        <!--<div class="col-sm-3">-->
        <!--<span class="pay_list_c1 selections"><input class="radioclass" type="radio" name="cost"-->
        <!--id="best" value="最好的治疗方法和材料"></span>-->
        <!--<label for="best" class="selection" style="font-weight: 500;margin-left: 10px;">最好的治疗方法和材料</label>-->
        <!--</div>-->
        <!--</div>-->
        <!--</div>-->
        <!--</div>-->

        <!--</div>-->
    </div>

</div>

<script src="${ctxPath}/static/js/common/jsAddresss.js"></script>
<script>
    $(function () {

//        初始化下拉媒介列表
//        $.post(Feng.ctxPath + "/medium/getThrMedium", function (data) {
//            console.log(data);
//            var txt = '';
//            data.forEach(function (key, value) {
//                txt += '<div class="col-sm-2" style="padding: 0;"><span class="pay_list_c1 projectDatas"><input class="radioclass" type="radio" name="about" value="' + key.mediumname + '" id="click_' + value + '"></span><label class="projectData" for="click_' + value + '" style="font-weight: 500;margin-left: 10px;">' + key.mediumname + '</label></div>'
//            });
//            document.getElementById('projectData').innerHTML = txt;
//
//        }, "json");
//
//        $("#required").click(function () {
//            $(this).css({"background": "#298bd6", "color": "white"}).siblings().css({
//                "background": "",
//                "color": "#676767"
//            });
//            $("#requiredBox").show();
//            $("#selectionBox").hide();
//        });
//        $("#selection").click(function () {
//            $(this).css({"background": "#298bd6", "color": "white"}).siblings().css({
//                "background": "",
//                "color": "#676767"
//            });
//            $("#selectionBox").show();
//            $("#requiredBox").hide();
//        });
//        $("#required").click();
        $(".required").click(function () {
            $(this).parents('.ulBox').find(".pay_list_c1").css("background", "#DCDCDC");
            $(this).siblings().css("background", "#289bd6")
        });

        $("#projectData").on('click', '.projectData', function () {
            $(this).parent().parent().find(".pay_list_c1").css("background", "#DCDCDC")
            $(this).siblings().css("background", "#289bd6")
        });

//        $(".selection").click(function () {
//            $(this).parent().parent().find(".pay_list_c1").css("background", "#DCDCDC")
//            $(this).siblings().css("background", "#289bd6")
//        });



        $(".requireds").click(function () {
            $(this).parents('.ulBox').find(".pay_list_c1").css("background", "#DCDCDC");
            $(this).css("background", "#289bd6")
        });

        $("#projectData").on('click', '.projectDatas', function () {
            $(this).parent().parent().find(".pay_list_c1").css("background", "#DCDCDC")
            $(this).css("background", "#289bd6")
        });

//        $(".selections").click(function () {
//            $(this).parent().parent().find(".pay_list_c1").css("background", "#DCDCDC")
//            $(this).css("background", "#289bd6")
//        });
    });


    var phoneSharShipValue = document.getElementById("phoneSharShipValue").value;
    if(phoneSharShipValue!="本人"){
        $("#phoneSharShip").hide();
        $("#customerPhone").css("width","60%")
    }

    document.getElementById("provinceValue").value = "湖北";
    document.getElementById("citiesValue").value = "武汉";
    document.getElementById("regionValue").value = "市辖区";
    var regioni = document.getElementById("regionValue").value;
    var provincei = document.getElementById("provinceValue").value;
    var citiesi = document.getElementById("citiesValue").value;
    addressInit('province', 'cities', 'region');

    var customerSexValue = document.getElementById("customerSexValue").value;
    if(customerSexValue!=null||customerSexValue!=""){
        $("#customerSex").find("option[value='"+customerSexValue+"']").attr("selected",true);
    }

    //确认提交
    function determine() {
        var customerName = $("#customerName").val();   //姓名
        var customerPhone = $("#customerPhone").val();   //手机
        var wechatNumber = $("#wechatNumber").val();   //微信号

        var occupation = $("#occupation").val();   //职业
        var sex = document.getElementById("customerSex").value;  //性别
        var about = $("input[name='about']:checked").val();  //来院途径
        var customerAge = document.getElementById("customerAge").value;  //年龄
        var phoneSharShip = document.getElementById("phoneSharShip").value;  //手机使用人

        var regioni = document.getElementById("regionValue").value;
        var provincei = document.getElementById("provinceValue").value;
        var citiesi = document.getElementById("citiesValue").value;
        var address = document.getElementById("address").value;

        var medicalReasons = $("input[name='reason']:checked").val();  //就诊原因
        var selectReasons = $("input[name='selectReasons']:checked").val();  //就诊原因
        console.log(medicalReasons);
        console.log(selectReasons);

        if (customerName == null || customerName == "") {
            alert("请输入姓名！");
            return;
        }
        if (sex == null || sex == "") {
            alert("请选择性别！");
            return;
        }
        if (customerAge == null || customerAge == "") {
            alert("请输入年龄！");
            return;
        }
        if (customerPhone == null || customerPhone == "") {
            alert("请输入手机号！");
            return;
        }
        if(regioni == null || regioni == ""){
            alert("请补全地址！");
            return;
        }
        if(provincei == null || provincei == ""){
            alert("请补全地址！");
            return;
        }
        if(citiesi == null || citiesi == ""){
            alert("请补全地址！");
            return;
        }
        if(address == null || address == ""){
            alert("请补全地址！");
            return;
        }
        if (selectReasons == null || selectReasons == "") {
            alert("请选择来院途径！");
            return;
        }
        $.ajax({
            url: Feng.ctxPath + "/customer/updateInformation",
            type: "post",
            data: {
                "customerName": customerName,
                "customerPhone": customerPhone,
                "wechatNumber": wechatNumber,
                "occupation": occupation,
                "regioni": regioni,
                "provincei": provincei,
                "citiesi": citiesi,
                "sex": sex,
                "age": customerAge,
                "about": about,
                "medicalReasons": medicalReasons,
                "selectReasons": selectReasons,
                "phoneSharShip":phoneSharShip,
                "address":address
            },
            success: function (data) {
                alert('提交成功!');
                window.location = "${ctxPath}/customer/customer_information"
            },
            error: function (data) {
                alert('提交失败!');
            }
        });
    }

</script>
@}
